Nursing Care for Pressure Ulcers

Patient Case Study

• Agnes Pimm, 74 years old, underwent knee replacement surgery and developed a stage 3 pressure ulcer on her leg due to supportive knee brace irritation.
• Ms. Pimm is independent, lives at home, and has a history of hypertension, smoking, and grief after her husband's death.
• She has a low protein and high sodium diet, struggles with appetite, and has difficulty accessing fresh foods.
• The wound is clean, without necrotic tissue, and exhibits no signs of inflammation or infection.
• Nurse Jessi Fletcher has been assigned to Ms. Pimm's care and assesses the patient's skin integrity.
• Nursing diagnoses include: Potential for infection related to pressure injury, Impaired skin integrity, Acute pain, Undernutrition, and Grieving.
• Ms. Pimm's care plan focuses on wound healing, infection prevention, nutrition, pain management, and smoking cessation.
• The care plan implementation includes teaching Ms. Pimm about medication administration, wound care, and infection prevention, as well as demonstrating the proper method for cleaning and dressing the pressure injury.
• Ms. Pimm is referred to a dietitian to create a wound healing meal plan suitable for her hypertension.
• Ms. Pimm struggles with her diet but shows an understanding of healthy eating and makes an effort to follow the dietitian's meal plan.
• Ms. Pimm struggles with smoking cessation despite trying various methods. She is referred to community resources for smoking cessation support.
• The nurse provides home health visits and the wound improves to stage 2 after a month of treatment.
• Over time, Ms. Pimm takes over wound care responsibilities and the frequency of home visits is reduced to three times a week.

Interventions for Patients at Risk for Impaired Skin Integrity

• Regular skin inspection: At least once a day, paying attention to bony prominences.
• Skin cleansing: Clean the skin when soiled and at routine intervals, using mild cleansing agents and gentle techniques.
• Minimize environmental factors: Avoid hot water, low humidity, and exposure to cold. Use moisturizers to treat dry skin.
• Avoid massage: Avoid massaging over bony prominences to minimize deep tissue trauma.
• Moisture management: Minimize skin exposure to moisture caused by incontinence, perspiration, or wound drainage. Use absorbent underpads and briefs, and change them frequently. Avoid placing plastic directly against the skin.
• Positioning and turning: Use proper positioning, transferring, and turning techniques to reduce friction and shear injuries.
• Pressure relief: Reposition the at-risk patient a minimum of every 2 hours using a written schedule.
• Positioning devices: Use pillows or foam wedges to protect bony prominences.
• Head of bed elevation: Maintain the head of the bed at the lowest degree of elevation consistent with the patient's medical condition.
• Assistive devices: Use assistive devices, such as a trapeze or drawsheet, to move patients who can't assist during transfers and position changes.
• Pressure-reducing devices: Use pressure-reducing devices for chair-bound patients.
• Written plan: Create a written plan for positioning, movement, and the use of positioning devices.
• Collaboration: Collaborate with physical therapists, primary caregivers, and other healthcare professionals.
• Patient and caregiver teaching: Educate patients and caregivers about pressure injuries, risk factors, skin care, and prevention strategies.
• Referral: Refer patients to home health agencies or community health departments for support.

Prevent Infection of Pressure Injuries

• Maintain skin hygiene: Keep the skin clean, dry, and moisturized.
• Maintain appropriate nutrition and hydration: Ensure adequate protein and carbohydrate intake and hydration status.
• Early recognition: Recognize early stages of pressure injuries for immediate intervention.
• Contact healthcare provider: Contact the healthcare provider at the earliest appearance of a pressure injury or change in skin integrity.
• Maintain activity levels: Encourage patients to maintain or improve current activity levels.

Prevent Nutritional Imbalance

• Assess dietary intake: Assess factors related to dietary intake.
• Nutritional supplements: Offer nutritional supplements.
• Mealtime support: Support patients during mealtimes.
• Consult dietitian: Consult with a dietitian if barriers to adequate nutrition exist.

Prevent Compromised Dignity and Situational Low Self-Esteem

• Assess for abuse and neglect: Assess for indicators of abuse or neglect during healthcare interactions.
• Build a trusting relationship: Develop a trusting, caring relationship with the patient.
• Educate patients and family members: Provide essential patient and family teaching to reduce the risk of pressure injury development and promote patient dignity.
• Assist with supportive devices: Assist patients and family members with obtaining supportive devices to help maintain appropriate positioning.

Evaluation

• Monitor skin integrity, comfort, and pain level regularly.
• Evaluate and modify the treatment plan as needed, potentially daily.
• Monitor dietary intake and consult with a nutritionist or dietitian if needed.
• Inform mobile patients when to call the office if they discover a potential pressure injury or change in skin integrity.

This quiz focuses on the case study of Agnes Pimm, a 74-year-old patient with a stage 3 pressure ulcer following knee replacement surgery. It covers nursing assessments, diagnoses, care plans, and patient education to promote wound healing and overall health management. Test your understanding of effective nursing care strategies for elderly patients with complex needs.